Being an elderly woman: is it a risk factor for morbidity after coronary artery bypass surgery?

Gender Differences in Predictors and Long-Term Mortality of New-Onset Postoperative Atrial Fibrillation Following Isolated Aortic Valve Replacement Surgery

PURPOSE

Postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG) has been associated with increased risk of death in women but not in men. We aimed to explore predictors and long-term mortality in POAF following isolated aortic valve replacement (AVR) surgery in men and women.

METHODS

This study included 379 severe aortic stenosis patients with no prior atrial fibrillation (AF) who underwent isolated AVR surgery. We used multiple logistic regression to investigate independent gender-specific predictors of new-onset POAF, and we performed Kaplan-Meier (KM) to determine the impact of POAF in long-term mortality according to gender.

RESULTS

Advanced age and coronary artery disease prevalence were higher among POAF patients in both genders. On multiple analysis, increased postoperative peak lactate was independently associated with POAF in men, while lower mean aortic valve gradient was associated with POAF in women. Area under the curve (AUC) for the model was 0.77 [0.68-0.86] and 0.69 [0.60-0.78] for men and women, respectively. At 4-year follow-up, POAF was linked to increased risk of death in men but not in women.

CONCLUSION

In severe aortic stenosis, factors associated with POAF and its impact on mortality differed between genders, with an increased risk of death observed only in men.

Gender Differences in Predictors and Long-Term Mortality of New-Onset Postoperative Atrial Fibrillation Following Isolated Aortic Valve Replacement Surgery

Purpose: Postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG) has been associated with increased risk of death in women but not in men. We aimed to explore predictors and long-term mortality in POAF following isolated aortic valve replacement (AVR) surgery in men and women.

Methods: This study included 379 severe aortic stenosis patients with no prior atrial fibrillation (AF) who underwent isolated AVR surgery. We used multiple logistic regression to investigate independent gender-specific predictors of new-onset POAF, and we performed Kaplan–Meier (KM) to determine the impact of POAF in long-term mortality according to gender.

Results: Advanced age and coronary artery disease prevalence were higher among POAF patients in both genders. On multiple analysis, increased postoperative peak lactate was independently associated with POAF in men, while lower mean aortic valve gradient was associated with POAF in women. Area under the curve (AUC) for the model was 0.77 [0.68–0.86] and 0.69 [0.60–0.78] for men and women, respectively. At 4-year follow-up, POAF was linked to increased risk of death in men but not in women.

Conclusion: In severe aortic stenosis, factors associated with POAF and its impact on mortality differed between genders, with an increased risk of death observed only in men.

Long-term outcome in men and women after CABG; results from the IMAGINE trial

BACKGROUND

The aim of this study is to determine sex differences in long-term outcome after coronary artery bypass grafting (CABG).

METHODS

The international randomized controlled IMAGINE study included 2553 consecutive patients with a left ventricular ejection fraction of >40% who underwent isolated CABG. Median follow-up was 32 months (IQR 17-42 months). The composite endpoint comprised of death, myocardial infarction (MI), cerebrovascular event, angina, revascularization and congestive heart failure. Cox regression analysis was used to examine sex differences in outcome post-CABG.

RESULTS

Of the 2553 patients, 2229 were men and 324 (13%) were women. Women were older and more often reported diabetes and hypertension. Smoking and impaired renal function were more prevalent in men. Women experienced a higher event rate during follow-up (composite endpoint 18% vs 12%; P = 0.007). Cox regression showed an increased risk of the composite endpoint in women after adjustment for age (HR 1.48 (95% CI: 1.11-1.97)) which was non-significant after additional adjustment for other confounders (HR 1.26 (95% CI: 0.92-1.72)).

CONCLUSION

Women have a worse long-term outcome after CABG than men in univariate analysis. However, after adjusting for potential confounders female sex became a non-significant predictor for prognosis, possibly due to the small sample size of women. Definite answers regarding sex-differences in long-term outcome after CABG should come from future pooling of studies comprising a larger number of women.

Low-level laser therapy prevents prodromal signal complications on saphenectomy post myocardial revascularization

BACKGROUND AND OBJECTIVE

One of the most frequent treatments for ischemic heart disease is myocardial revascularization, often applying the saphenous vein as a coronary graft. However, postoperative complications may occur, such as saphenous dehiscence. According to the literature, low-level laser therapy (LLLT) has been used in the treatment of several inflammatory processes in patients. Recently, its uses have expanded to include LLLT preventive therapy and postoperative treatment. Despite our department's successful application of LLLT in the treatment of saphenectomy incisions, many colleagues are still uncertain as to laser therapy's benefits. Therefore, the study's purpose was to evaluate tissue repair of prodromal surgical incisions after the administration of LLLT.

MATERIALS AND METHODS

The pilot study included 14 patients, divided into two groups. Both groups of patients received the traditional treatment; additionally, the Laser Group (n = 7) received diode laser treatment (λ = 780 nm, fluence = 19 J/cm(2), pulse = 25 mW, time = 30 sec, energy = 0.75 J, irradiance = 625 mW/cm(2), beam spot size 0.04 cm(2)), which was applied on the edges of the saphenectomy incision. The Control Group (n = 7) received conventional treatment exclusively.

RESULTS

In the Laser Group: all seven patients showed significant improvement, whereas the Control Group had twice as many complications, including critical rates of incisional dehiscence.

CONCLUSIONS

LLLT was valuable in preventing prodromal complications in saphenectomy post myocardial revascularization.

Female gender and the risk for death after cardiac surgery in septuagenarians and octogenarians: a retrospective observational study

BACKGROUND

In elderly patients, the impact of gender on outcome after cardiac surgery is a debated topic of ongoing relevance.

OBJECTIVE

This study assessed the hypothesis that, among septuagenarians and octogenarians, women have poorer outcomes compared with men after cardiac surgery.

METHODS

For this retrospective observational study, the electronic medical records of patients who underwent cardiac surgery between January 2006 and August 2009 at Department of Cardiothoracic Surgery, University Medical Center, Regensburg, Germany, were reviewed. The primary end points were the proportions of women and men with in-hospital and 30-day mortality, and postoperative morbidity was considered a secondary end point.

RESULTS

The records of 598 patients were reviewed (274 female [137 septuagenarians, 162 octogenarians; mean (SD)] age, 77.8 [4.8] years]; 324 male [137 septuagenarians, 162 octogenarians; mean age, 78.3 [4.8] years]; all, P = NS). At baseline, the gender groups differed significantly with respect to mean logistic European System for Cardiac Operative Risk Evaluation score (EuroSCORE) (used for calculating expected mortality) (11.9% in women, 9.9% in men; P = 0.007), rate of diabetes mellitus did not reach statistical significance ([statistical significance was considered at P < 0.05] 12.4% vs 7.4%; P = 0.052), rate of renal dysfunction (51.5% vs 28.6%; P < 0.001), proportion undergoing isolated valve surgery (43.1% vs 24.7%, respectively; P < 0.0001), and perfusion technique (conventional [83.2% vs 69.4%] vs minimized [16.8% vs 30.6%] extracorporeal circulation) (P < 0.0001). In-hospital mortality (7.3% vs 5.6%; P = 0.404) and 30-day mortality (8.0% vs 5.9%; P = 0.332) were not significantly different between genders. There were no significant differences in mortality with respect to age group. On multivariate analysis, age and female gender were not found to be independent risk factors for early mortality. The between-gender differences in postoperative morbidity, including central neurologic event (P = 0.412), need for dialysis (P = 0.491), and respiratory insufficiency (P = 1.00), were nonsignificant, as were median durations of intensive care unit stay (P = 0.68) and hospital stay (P = 0.52) stay.

CONCLUSION

In septuagenarians and octogenarians, female gender was not associated with increased risks for morbidity and mortality after cardiac surgery.

Coronary bypass surgery in a 105-year-old patient with cardiopulmonary bypass

Coronary artery bypass grafting is one of the routine daily surgical procedures in the current era. Parallel to the increasing life expectancy, cardiac surgery is commonly performed in octogenarians. However, literature consists of only seldom reports of coronary artery bypass grafting in patients above 90 years of age. In this report, we present our management strategy in a 105-year-old patient who underwent coronary artery bypass grafting at our institution.

Postoperative Revision Surgery for Bleeding in a Tertiary Heart Center

We analyzed cases of re-exploration for bleeding after 19,680 open heart operations performed between January 1995 and January 2009 to determine the risk factors for mortality and morbidity. Half of the 282 patients reexplored had nonsurgical causes of bleeding. The patients were grouped according to the timing of reoperation, early reexploration being on the day of the operation. Mortality, total morbidity, and the need for transfusion of any blood product were compared between the early and late reexploration groups. Most patients (77.7%) were reexplored early. Overall mortality was 8.5% (24 patients). Mortality, total morbidity, renal, gastrointestinal, neurologic and infectious complications, and low cardiac output differed significantly between the 2 groups. Significant predictors of mortality were old age, female sex, left ventricular dysfunction, noncoronary operations, and delayed reoperation. Predictors of morbidity were old age, preoperative dialysis, tobacco use, chronic lung disease, and delayed reoperation. No factors were found to be associated with the need for transfusion.